gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Persistence of evidence-based secondary prevention among patients after myocardial infarction – a claims data analysis

Persistenz evidenzbasierter Sekundärprävention bei Patienten nach Myokardinfarkt – eine Routinedatenanalyse

Meeting Abstract

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  • corresponding author Sandra Mangiapane - Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
  • Reinhard Busse - Berlin University of Technology, Berlin, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa18

The electronic version of this article is the complete one and can be found online at:

Published: November 6, 2008

© 2008 Mangiapane et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: Several RCTs have shown that the prognosis of patients after myocardial infarction (AMI) could be improved by the use of aspirin, clopidogrel, beta-blockers, statins and ACE inhibitors. However, many patients fail to consistently remain on these treatments over time, whereas long-term persistence has not been well described. The aim of this study was to analyse the persistence of secondary prevention among survivors of hospital admissions for AMI between 2001 and 2006.

Material and method: A cohort study was carried out, using claims data from the Techniker Krankenkasse for the years 2001-2006. Patients were included if they had at least one discharge diagnosis for AMI and were constantly enrolled >= 90 days after admission. According to the prescriptions within 90 days after discharge, patients were marked as user of the relevant drug classes. The prescribing data were analysed for up to 5 years after the index prescription to identify how many patients had stopped treatment (gap between two prescriptions > 90 days). Survival analysis was used to estimate the likelihood of stopping treatments over time. As the prescribed daily dose was not included in the data, a 2% random sample of prescription images was drawn to investigate which dosage assumption (“DDD”, “lowest or highest recommended dosage”, “one pill per day”) agrees best with the dosage advice written on the prescription.

Results: Of approximated 6.7 Mio insurants eligible for the analysis, n=30,028 patients had at least one discharge diagnosis for AMI between 2001and 2006. 82% of these patients received a beta-blocker, 73% a statin, 69% an ACE inhibitor, 66% aspirin and 61% clopidogrel within 90 days after discharge. At 5 years after discharge, 90% of the aspirin users, 83% of the statin users, 69% of the ACE inhibitor users and 64% of the beta-blocker users have stopped the treatment. The most considerable drops in persistence could be observed between the first and the second year after discharge. Of the 2,152 randomly sampled prescription images, only 15% embodied a written dosage advice in the prescription. The dosage assumption “1 pill per day” agreed best with the advice written on the prescription.

Conclusion: Even though prevalence of drug treatment for secondary prevention after myocardial infarction is initially high, there is a large need for optimizing long term persistence. Quality improvement efforts should focus on improving discharge planning and early patient and family education programs, as the highest risk for discontinuation could be observed within the first two years after discharge.